Peer-reviewed veterinary case report
Reverse Trendelenburg position lowers reflux risk in dogs under
By Hickey, Colleen et al.·Published in Veterinary anaesthesia and analgesia·2023·Department of Veterinary Clinical Sciences, United States·View original on PubMed →
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Original publication title: Effect of the reverse Trendelenburg position on the incidence of gastroesophageal reflux in dogs anesthetized for elective stifle surgery.
- Species:
- dog
Plain-English summary
A group of 36 healthy dogs undergoing stifle surgery were monitored for gastroesophageal reflux (GER), which can cause discomfort and complications during anesthesia. The dogs were placed in either a 15-degree elevated position or a flat position during surgery. Despite the change in positioning, about 30% of the dogs experienced GER, with no significant difference between the two groups. This means that the elevated position did not help reduce the chances of reflux during the procedure.
People also search for: dog surgery reflux · gastroesophageal reflux in dogs · stifle surgery anesthesia issues
Abstract
OBJECTIVE: To determine if a 15° reverse Trendelenburg position decreases the incidence of gastroesophageal reflux (GER) compared with a horizontal position in dogs anesthetized for stifle surgery. STUDY DESIGN: Prospective, randomized parallel-arm study. ANIMALS: A total of 44 healthy client-owned dogs were enrolled and data from 36 dogs were analyzed. METHODS: Dogs requiring preoperative radiographs under anesthesia, or with a history of gastrointestinal signs or administered gastroprotectant therapy within 1 month of surgery were excluded. Anesthesia protocol was standardized to include hydromorphone, dexmedetomidine, ketamine, propofol and isoflurane. Dogs were randomly assigned at enrollment to be positioned in a 15° reverse Trendelenburg or a horizontal position for surgery. Continuous pH monitoring was documented throughout the procedure with a 6.4 Fr (2.13 mm) esophageal pH probe positioned in the distal esophagus via the oral cavity. GER was defined as pH < 4.0 (acidic) or > 7.5 (alkaline) for more than 30 seconds. The proportions of dogs developing GER were compared between groups using Fisher's exact test. Time to reflux was compared using survival curves and the Gehan-Breslow-Wilcoxon test. Statistical significance was set as p < 0.05. RESULTS: An episode of GER occurred in 11/36 (30%) dogs. Reflux was alkaline in two dogs and acidic in nine dogs. The proportion of dogs with GER was 5/18 (28%) and 6/18 (33%) for dogs in the reverse Trendelenburg position and horizontal position, respectively, and was not statistically significant (p > 0.99). Median (range) time until reflux was 44 (23-135) and 44.5 (9-56) minutes when dogs were positioned in reverse Trendelenburg position and horizontal position, respectively (p = 0.66; two-tailed Mann-Whitney U test). CONCLUSIONS AND CLINICAL RELEVANCE: Positioning the surgery table in a 15° rostral elevation for dogs anesthetized for elective stifle surgical procedures did not decrease the incidence of GER.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/37164789/